Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trafford Health Centre on 28th October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The system would be more effective if all practice staff were included in discussions about learning outcomes.
• Risks to patients were mostly assessed and well managed with one exception. Workload was poorly monitored which resulted in delays attending to post, blood tests and repeat prescriptions.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments and same day appointments always available. The practice was open from 8am until 8pm seven days a week.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The over-arching organisational structure did not support the individual needs of the practice and the governance was inconsistent. The practice recognised that improvements were required in this area. Despite this, staff said they felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

Areas where the provider must make improvements.

• The provider must assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others that arise from the carrying on of the regulated activity. They must ensure that the governance structure is such that workload and staff are suitably managed to avoid risks to the safety of patients.

Areas where the provider should make improvements.

• Not all staff were included in meetings about significant events and learning from significant events was not shared with the whole practice team. This included discussions about safeguarding and palliative care patients which were not always reported and discussed in a timely manner.

• The practice did not monitor that minutes and messages displayed in the staff kitchen are received and actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients who attended Trafford Health Centre had access to a range of information about the services provided. Leaflets were available in the reception area, with information displayed around the centre. The service had access to interpreter services if this was required.

We observed that patients were greeted in a professional manner. One patient told us: "From the receptionist, Dr and nurse, everyone has been pleasant and I was immediately put at ease".

Care was provided in an environment that was clean, well maintained and organised. Patients were either attending the walk in centre with minor injuries or illness or had an appointment at the GP service, at which they were registered. An out of hours service was also provided each week night until 8pm and at weekends.

We found that Trafford Health Centre had appropriate systems in place to safeguard children and adults whilst using the service.

The service provided monthly and quarterly quality reports to NHS Trafford, as part of the commissioning contract. This included performance data, patient equity of access data and clinical effectiveness data. We saw that there were no concerns from the commissioning team.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trafford Out of Hours GP Service (Part of Mastercall Healthcare) on 6 March 2017. Overall the provider is rated as good.

Our key findings across all the areas we inspected were as follows:

• The provider demonstrated an open and transparent approach to safety; and a clear cohesive system was in place for reporting, recording and providing feedback on significant events, identified risks, near misses, patient complaints and safeguarding referrals.
• The Quality and Safety Team held profiles relating to identified risks, complaints, significant events and safeguarding referrals. Risk ‘champions’ had been identified amongst the workforce to encourage high levels of reporting amongst staff.
• The service was monitored against the National Quality Requirements (NQRs) and Key Performance Indicators (KPIs). The data provided information to the provider and commissioners in relation to the level and quality of service being delivered. Where variations in performance were identified, the reasons for these were reviewed and action plans implemented to improve the service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received appropriate training and updating which provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Performance monitoring processes were in place. Clinicians received weekly audits of their clinical practice using the Royal College of GPs (RCGP) urgent care tool the ‘Clinical Guardian’ system.
• The provider had developed in-house software to support individual ‘My Performance’ reports which benchmarked individual clinicians against their peers in relation to assessment outcomes, for example in relation to percentage of patients who received telephone advice, or who attended treatment centres or hospital.

• Following initial assessment by NHS111 service, patients were triaged by clinicians at International House and offered telephone advice, a face to face appointment at Stockport or Trafford; or a home visit, in accordance with the disposition (outcome) of the assessment.

• Information about services and how to complain was available on the provider website and in house at treatment centres. Complaints were investigated and patients received an apology and explanation of actions taken as a result of their complaint.

• Staff had access to safeguarding policies and procedures and received training appropriate to their role. Staff demonstrated their awareness of their safeguarding responsibilities in relation to vulnerable children and adults; including frequent callers to the service.

• Vehicles used to transport GPs to home visits were clean, well maintained and appropriately equipped. Patient Transport Services were available for those patients without transport, who needed to access a treatment centre

• There was a clear leadership structure within the organisation. Staff we spoke with described feeling supported by immediate and senior managers.

• The provider proactively sought feedback from staff and patients, and acted on this feedback.

• There were systems in place to provide integrated person-centred care. Staff had access to information relating to end of life care through the use of Special Patient Notes, EMIS viewer and Electronic Palliative Care Co-ordination System (EPaCCS).

• The provider was aware of, and complied with the requirments of the duty of candour.

We saw areas of outstanding practice:

• The provider was the first out of hours service to be awarded ‘Daisy’ accreditation, which originated from the National Dignity Council, and had been adopted by Community Healthcare Trusts for Tameside, Glossop and Stockport; for dignity in care. Dignity champions had been identified throughout the service to reinforce this approach.

However the provider should:

• Improve uptake of annual appraisals, particularly in relation to nursing staff.

• Continuously monitor, review and develop action plans in relation to their performance against National Quality Requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice